Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1184812885 |
---|---|
Provider Name | Mrs. Shannon Vuylsteke |
First Address | Cornelius, OR 97113-9166 |
Second Address | Hillsboro, OR 97124-5860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 25/10/2007 |